Role of AYUSH workforce, therapeutics and principles in health care delivery.

Abstract

Introduction

AYUSH is an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy and are the six Indian systems of medicine prevalent and practiced in India and some of the neighboring Asian countries with very few exceptions in some of the developed countries. A department called the department of Indian system of medicine was created in March 1995[1,2] and renamed to AYUSH in November 2003[3] with a focus to provide increased attention for the development of these systems. This was felt in order to give increased attention to these systems in the presence of a strong counterpart in the form of allopathic system of medicine which lead to an “architectural correction” in the health service envisaged by National Rural Health Mission (NRHM). Before the initiation of NRHM most of these systems including workforces, therapeutics and principles were limited to their own field with few exceptions in some states, as health in India is a state issue. This took a reverse turn after the initiation of NRHM and the AYUSH systems were brought into the mainstream health care. NRHM came into play in 2005 but implemented at ground level in 2006 and introduced the concept of “mainstreaming of AYUSH and revitalization of local health traditions” to strengthen public health services.[4,5] This concept helped in utilizing the untapped AYUSH workforce, therapeutics and the principles for the management of community health problems at different levels. This convergence has been envisaged with the following objectives:

• Choice of the treatment system to the patients
• Strengthen facility functionally
• Strengthen implementation of national health programs.[3,4,5]

In the mainstreaming of AYUSH and revitalization of local health traditions AYUSH workforce, therapeutics and principles have been implemented in various states at a different level.

Methodology

A review based study. Information pertaining to this study was primarily obtained from various governmental documents in the concerned domain.

Discussion

This section delineates the role of AYUSH workforce, therapeutics and principles. As the paper focuses on the role of AYUSH system with special reference to NRHM, hence a discussion on mainstreaming of AYUSH and revitalization of local health traditions is very much imperative. The concept of mainstreaming of AYUSH was an idea in the 9^th five year plan before it was actually implemented in the country by NRHM in 2005.[3] By this AYUSH doctors are co-located in various health facilities such as Primary Health Center (PHC), Community Health Center (CHC), sub district hospital, and district hospital (DH). AYUSH facilities have been created in 468 DHs, 2483 CHCs and 8520 PHCs as on 31/03/2012. About 76.3% DHs, 51.6% CHCs and 35.7% PHCs have been co-located with AYUSH facilities by this time. As on 31/03/2012 there were 1,0439 AYUSH doctors and 4146 paramedical staffs serving in India. A maximum of 1386 doctors have been appointed in the state of Bihar, whereas Orissa and Rajasthan have 1237 and 1013 AYUSH doctors appointed respectively. Delhi and Jharkhand are the only two states where AYUSH doctors have not been appointed. In case of paramedical staffs, Andhra Pradesh is the state where a maximum of 1500 number of AYUSH paramedical staffs have been appointed. AYUSH paramedical staffs have not been appointed in many states like Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Delhi, Gujarat, Jharkhand, Meghalaya, Mizoram, Nagaland, Orissa, Uttar Pradesh, Dadra-Nagar Haveli and Diu-Daman [Figures ​[Figures11 and ​and22].[1] Similarly about 17.7 lakhs of rural population were being served by each DHs, 3.3 lakhs of the rural population were being served by each CHCs and 1.0 lakhs of the rural population were being served by each PHCs in various states/UTs wherever the corresponding facilities existed [Tables ​[Tables11 and ​and22].[1] The required number of AYUSH workforces has been articulated in the Indian Public Health Standards (IPHS) documents [Table 3].[6,7,8,9] The role and responsibilities of AYUSH doctors have been spelt out very carefully in their term of reference (TOR). As per the TOR, an AYUSH doctor should support in the implementation of national health programs after requisite training if required. Training and orientation of AYUSH doctor is one of the important agenda of NRHM. There are some job responsibilities mentioned under the TOR which are beyond the scope of an AYUSH doctor as per his/her educational training and exposure. Let us pick up some responsibilities mentioned in the TOR of AYUSH doctors in Orissa; conducting minor surgery, abscess surgery, conducting normal delivery and insertion of intrauterine contraceptive devices are beyond the scope of an AYUSH doctor as per their training and exposure. Similarly planning and implementation of national disease control program, national health programs such as immunization program, Reproductive and Child Health program, supervision of Village Health Nutrition Day and Pustikar Divas, implementation of Integrated Management of Neonatal and Childhood Illnesses requires a lot of training and orientation of AYUSH doctors